=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720872807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEONIA GLOVER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2025
-----------------------------------------------------
Last Update Date | 04/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10980 NORCOM RD
-----------------------------------------------------
City | PHILA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19154-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-677-1149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1532 SAINT LUKE ST
-----------------------------------------------------
City | PHILA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-688-7823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MSG006325
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------